Urinary incontinence Archive

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Q. I am 74 years old and unsure whether I want to continue with PSA screening for prostate cancer. Before deciding, I wanted to better understand my options since I probably would not want surgery or radiation therapy if I do have prostate cancer. What is your approach?

A. No matter what your age, men should ask themselves these types of questions before having a blood test for PSA (prostate-specific antigen) to look for hidden prostate cancer.

Research we're watching

Women who use marijuana may have more difficulty getting pregnant than women who don't, according to a study published online Jan. 11, 2021, by the journal Human Reproduction.

The study looked at 1,200 women who were trying to conceive after experiencing either one or two miscarriages. The researchers followed the women for six monthly cycles and tracked those who became pregnant for the duration of their pregnancy. Those who reported using marijuana or hashish in the past 12 months or whose urine samples showed evidence of cannabis were 40% less likely to get pregnant during each monthly cycle than those who didn't use cannabis. Only 42% of the cannabis users became pregnant during the study period, compared with 66% of non-users. There did not, however, appear to be any difference in miscarriage rate between users and non-users. The study authors said that further research is needed to confirm the results.

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Q. I had a major heart attack earlier this year and received a drug-eluting stent. My doctor tells me that it's now safe to exercise and engage in sexual activity. But is it safe to use erectile dysfunction (ED) medications?

A. Most men who have recovered from a heart attack can resume their usual sex life. Once your doctor allows you to engage in moderate aerobic activity — sexual activity is often equated to the exercise level of brisk walking — you may safely use ED medications with certain precautions.

The best prevention for bone-thinning osteoporosis begins early — during the first two decades of life, when you can most influence your peak bone mass by getting enough calcium and vitamin D and doing bone-strengthening exercise. If you are over age 20, there's no need to be discouraged. It's never too late to adopt bone-preserving habits.

If you are a man younger than 65 or a premenopausal woman, these five strategies can help you shore up bone strength as a hedge against developing osteoporosis.

Can adopting a healthier diet help fight prostate cancer? That's a question men newly diagnosed with prostate cancer often ask their doctors.

Several studies have shown that in countries where men eat a typical "Western" diet containing a large amount of meat, the incidence of prostate cancer, especially aggressive prostate cancer, is higher than in countries where plant-based foods are a primary part of the diet. Unfortunately, these studies weren't designed to prove cause and effect. So for now, definitive answers about prostate cancer and diet aren't yet in — although researchers are actively studying this topic.

Recent advances can help men with a worrisome PSA result avoid immediate biopsy.

Prostate-specific antigen (PSA) blood testing receives high marks as an effective way to monitor disease activity in men diagnosed with prostate cancer. Yet, as a screening tool for prostate cancer, PSA testing is problematic.

PSA naturally tends to increase as men get older, but levels that get too high may suggest prostate cancer. A PSA level of less than 4 nanograms per milliliter (ng/mL) is often reassuring, unless there has been a sudden jump from a much lower number. Many doctors consider a total PSA level higher than 10 ng/mL as the threshold for getting a biopsy to check for cancer.

Cardiovascular problems can conspire to put a damper on sexual enjoyment. Talking to your doctor and your partner can help.

A physical connection with your romantic partner is often an important part of a fulfilling relationship. But when it comes to matters of the heart, the health of your heart matters.

"A satisfying sex life depends on physical health, psychological well-being, and the quality of the relationship," says Dr. Jan Shifren, who directs the Massachusetts General Hospital Midlife Women's Health Center. Heart disease and related conditions can influence all three of those factors in both men and women. Here's a look at the range of those effects and some possible solutions.

Whittle your waist for better health.

You've probably heard that extra pounds around your middle are bad for your heart. But a new study has found that excess weight in your belly — a body shape doctors refer to as central adiposity — may be even worse for women's heart health than men's.

The study, in the March 6 issue of the Journal of the American Heart Association, involved about 500,000 people (55% of them women), ages 40 to 69, in the United Kingdom. The researchers took body measurements of the participants and then kept track of who had heart attacks over the next seven years. During that period, the women who carried more weight around their middles (measured by waist circumference, waist-to-hip ratio, or waist-to-height ratio) had a 10% to 20% greater risk of heart attack than women who were just heavier over all (measured by body mass index, or BMI, a calculation of weight in relation to height).

Preterm birth joins other pregnancy-related conditions as potential heart risk factors.

 Image: © metinkiyak/Getty Images

Preterm birth has long been known to bring health risks for the baby, but it may also bring risks for the mother. A study in the June issue of Hypertension shows that women who gave birth to a baby before 37 weeks of pregnancy were more likely to experience rising blood pressures later on compared to women who delivered closer to term. If they had this pattern, they were also more likely to show signs of coronary artery disease, which is associated with an increased risk of heart attack and stroke.

Because of the unique demands that pregnancy places on a woman's body, it may serve as a stress test for the female heart, says Dr. JoAnn E. Manson, the Michael and Lee Bell Professor of Women's Health at Harvard Medical School. In the May issue, we talked about how other pregnancy-related conditions — gestational diabetes, pre-eclampsia (a type of pregnancy-induced high blood pressure), and other pregnancy-related hypertensive disorders — can raise a woman's risk of developing cardiovascular disease. Preterm birth should now join that list, says Dr. Manson.

If you've had a stone, the problem is likely to recur — but it doesn't have to. Use these strategies for prevention.

The pain associated with kidney stones has been described by some as more excruciating than childbirth. Kidney stones are small, hard stones, formed when high levels of minerals in your urine start to crystallize in your kidneys, forming a pebble-like mass. The pain comes when these stones migrate from your kidneys through the ureters, which are the narrow tubes that carry urine from your kidneys into your bladder.

"Kidney stone pain is not subtle," says Dr. Gary Curhan, a professor of epidemiology at the Harvard T.H. Chan School of Public Health. It typically starts in the flank, at the side of the lower back. Sometimes if the stone moves, the pain migrates to the front of the body.